Thoughts and ideas from The Physician Executive
“Crucial Conversations”: Ten Tips For Physician Leaders
May 14, 2019 at 12:00 AM
by The Physician Executive
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When last did you have a tough conversation with an employee, a colleague or a family member that went really, really well?

As a physician, you are well aware there are certain difficult conversations that we are well-trained to have — delivering difficult diagnoses or alarming prognoses to patients and their families. However, I’d argue that these are not true “crucial conversations” … at least for us.

As a physician leader, perhaps you’ll agree once you see the definition below.

In fact, most of us struggle to tackle those conversations that seem destined to flare up into full-blown conflict or hostility … or at least that’s our fear.

Since this topic has come up in my physician leadership coaching recently, it’ s timely to offer ten tips, based on the excellent book “Crucial Conversations: Tools for talking when the stakes are high” by Patterson, Grenny, McMillan and Switzler.

What is a crucial conversation? 

It has 3 elements:

· opinions are varied

· stakes are high

· emotions run high

Now does that sound familiar?

Ten tips to success with your next Crucial Conversation:

Use these tips to guide you when, in your physician leadership role, you next anticipate having such a conversation, or you find yourself in the middle of one.

1. “Start with Heart”: begin by taking a long hard look at yourself.
What are your motives for having the conversation?
What do you really want as a result?
How can you work on yourself to get that result?

2. Understand that when emotions run high, yours or others’, your rational thinking brain shuts down to some extent.
How can you stay focused on the desired outcome and not get sidetracked into name-calling “(Violence”) or withdrawing (“Silence”)?

3. Stay away from “either/or” choices (in the book they are called Sucker’s Choices) and opt for the “and … and” — the idea that there is ALMOST ALWAYS another option no matter how challenging it may seem to get to the desired outcome.

4. Keep coming back to Dialogue (“the free flow of meaning between two or more people”) by repeating “What do I really want for myself?”, “What do I really want for others?”, “What do I really want for the relationship?” and “How would I need to behave if Ireally wanted these results?” These questions, when motivated by your desire for authenticity, should provoke honest assessments.

5. Create safety for the conversation. Spot the moment when the other person is either moving to hurt and anger (“violence”) or fear and withdrawal (“silence”).

6. Get clear about your Mutual Purpose – why bother having this talk?

7. Get clear about the Mutual Respect that is necessary for the talk to continue.

8. Step out of the conversation, build safety, and then go backto the discussion at hand.
You can use phrases like “Can we change gears for a minute?
Check in with yourself to see if an apology is called for – if you went too far.
Clarify potential misunderstandings (in the book, the technique is called “Contrasting”).

9. Recognize the difference between the FACTS and the STORIES or interpretations that get made up to explain the facts. It goes something like this:
We observe something >> we tell a story to ourselves about what we observe >>this generates one or more feelings inside us >> and then we act or react.
Our partner keeps leaving the bathroom in a mess (the FACT is there are dirty clothes on the floor near the shower, and the sink counter has three toothpaste smears), we tell ourselves that he/she doesn’t care enough about us or value us (our story is created masterfully from what we observed), we become furious (our feeling) and then we launch into a tirade about how uncaring and disrespectful he/she is.
Mastering our stories may be one of the most important steps as it allows us to recognize our tendency to demonize the other, and instead move towards humanizing them.

10. Use the STATE skills to express your point of view.
Share your facts.
Tell your story
Ask for other’s facts and stories
Talk tentatively – don’t be absolutely positively correct
Encourage testing – make it safe for others to express a differing point of view.

There are many invaluable tools in the book. The biggest takeaway is that this skill takes enormous practice AND is eminently learnable!

Addendum: coincidentally, HBR published a post today titled "What Good Feedback Really Looks Like" that provides some excellent pointers for giving your peers, employees, and even your boss the kind of feedback that excourages positive behavior change.